We are looking for Clinical Documentation Integrity (CDI) Leader candidates for a project delivered through Mercor.
What you'll do
- Lead clinical documentation integrity programs for inpatient and/or outpatient settings, overseeing concurrent and retrospective review workflows.
- Evaluate AI-generated clinical documentation improvement suggestions, physician queries, and coding recommendations for clinical accuracy and compliance.
- Conduct and review clinical documentation to ensure accurate capture of diagnoses, procedures, severity of illness, and risk of mortality.
- Develop and manage physician query processes in alignment with AHIMA and ACDIS guidelines.
- Monitor CDI program KPIs including query response rates, CC/MCC capture rates, case mix index, and DRG accuracy.
- Collaborate with coding, compliance, and clinical teams to address documentation gaps and improve query processes.
- Provide education to physicians and clinical staff on documentation requirements and best practices.
- Ensure compliance with Official Coding Guidelines, CMS regulations, and payer-specific requirements.
- Annotate AI outputs and provide structured clinical feedback to support AI training datasets.
What you need
- 5+ years of experience in clinical documentation integrity or improvement, with at least 2 years in a manager or leadership role.
- Deep knowledge of MS-DRG methodology, CC/MCC hierarchies, and ICD-10-CM/PCS coding guidelines.
- Expertise in physician query management per AHIMA and ACDIS compliant query standards.
- Strong clinical background with the ability to interpret medical records and clinical documentation.
- Proficiency with CDI software platforms (3M, Nuance, Optum360, or equivalent) and EHR systems.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to critically evaluate clinical documentation and AI-generated outputs.
- Comfortable working independently in a fully remote environment.
Nice to have
- CCDS (Certified Clinical Documentation Specialist) or CDIP (Clinical Documentation Improvement Practitioner) credential.
- Experience with HCC risk adjustment and outpatient CDI programs.
- Background in RN, RHIA, CCS, or similar clinical or coding credential.
- Familiarity with AI-assisted CDI tools (e.g., Nuance DAX, 3M M\*Modal) and comfort evaluating AI-generated clinical content.
- Experience presenting CDI performance metrics to clinical and executive leadership.
Who you work with
Project and contracting process: Mercor. Applications continue on the provider's website.